Simulation training in laparoscopy using a computerized physical reality simulator.

Objective: To describe a new simulator, SurgicalSIM LTS, and summarize our preliminary experience with system.

Methods: LTS was evaluated in 3 studies: (1) 124 participants from 3 Canadian universities: 13 students; 30 residents, fellows, attendings from surgery; 59 gynecologists; 22 urologists were classified based on laparoscopic experience as novice, intermediate, competent, or expert. All were tested on the LTS. Seventy-four were tested on the LTS and MISTELS (McGill Inanimate System for Training and Evaluation of Laparoscopic Skills). Participants completed a satisfaction questionnaire. (2) Twenty-five international gynecologists in-training at Kiel Gynaecologic Endoscopy Center, and 15 students from the center pretested on LTS underwent voluntary additional trials and posttesting. (3) Seventeen experienced laparoscopic surgeons from 3 specialties were recruited to perform on randomly assigned simulators involving 5 commercial, computer-based systems. The surgeons practiced repetitively for 1.5 days. Efficient, error-free performance was measured and proficiency score formulas were developed.

Results: Study A: LTS showed a good correlation with level of experience (P=0.000) and MISTELS (0.79). Satisfaction: LTS vs MISTELS 79.9 vs 70.4 (P=0.012). Study B: Posttest scores were significantly better in all tasks for both groups, P<0.0001. Group mean scores with < or =5 trials were significantly better than with 2 or 3 trials (P<0.012, P<0.018). Study C: LTS had the highest effectiveness rating of the 5 simulators.

Conclusions: A new computerized physical reality simulator can be used to assess/train laparoscopic technical skills.